Mikami Takeshi, Minamida Yoshihiro, Koyanagi Izumi, Baba Takeo, Houkin Kiyohiro
Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
J Neurosurg. 2007 Jan;106(1):170-4. doi: 10.3171/jns.2007.106.1.170.
An anterior clinoidectomy can provide enormous benefits, facilitating the management of paraclinoid and upper basilar artery lesions, but it also carries the potential risk of cerebrospinal fluid leaks. The aim of this study was to assess the variation in the pneumatization of the anterior clinoid process (ACP) in an attempt to reduce the complications associated with an anterior clinoidectomy.
The authors analyzed the anatomical variations in the pneumatization of the ACP and optical strut (OS) in 600 sides of 300 consecutive patients by using multidetector-row computed tomography (CT). Computed tomography scans with a 0.5-mm thickness were obtained, and coronal and sagittal reconstructions of the images were displayed in all cases. Pneumatization of the ACP was found in 9.2% of all sides. The origin of pneumatization was the sphenoid sinus in 81.8% of all the sides, the ethmoid sinus in 10.9%, and both of these sinuses in 7.3%. Pneumatized patterns were divided into three groups according to the route: 74.5% were Type I, in which pneumatization occurred via the OS; 14.5% were Type II, pneumatization via the anterior root (AR); and 10.9% were Type III, pneumatization via both the OS and the AR. The origin of pneumatization and the pneumatization pattern showed statistical dependence (p < 0.001). Pneumatization of the OS beyond its narrowest point was found in 6.8% of all sides.
An awareness of the different variations in pneumatization can prevent destruction of the mucous membrane and facilitate orientation during reconstruction with cranialization. During an anterior clinoidectomy, preoperative CT assessments are necessary to evaluate pneumatization of the ACP.
前床突切除术可带来诸多益处，有助于处理床旁和基底动脉上段病变，但也存在脑脊液漏的潜在风险。本研究旨在评估前床突（ACP）气化的变异情况，以尝试减少与前床突切除术相关的并发症。
作者通过使用多排螺旋计算机断层扫描（CT）分析了连续300例患者600侧的ACP和视神经管（OS）气化的解剖变异。获得了厚度为0.5毫米的CT扫描图像，并对所有病例进行了图像的冠状位和矢状位重建。在所有侧别中，9.2%发现有ACP气化。气化的起源在81.8%的侧别中为蝶窦，10.9%为筛窦，7.3%为这两个窦均有。根据气化途径，气化模式分为三组：74.5%为I型，即通过OS气化；14.5%为II型，通过前根（AR）气化；10.9%为III型，通过OS和AR均气化。气化的起源和气化模式显示出统计学相关性（p < 0.001）。在所有侧别中，6.8%发现OS在其最窄点以外有气化。
了解气化的不同变异可防止黏膜破坏，并有助于颅骨化重建过程中的定位。在前床突切除术中，术前CT评估对于评估ACP的气化情况是必要的。
